some cardiac related questions

[luvyrpets]

I have searched and cannot find the answer to some questions.

I thought it was 1 but I got it wrong. Now I am thinking

it is 3. But that level seems to be ok.

Which cardiac isoenzyme level might be useful in identifying whether a

myocardial infarction occurred?

1) CPK-MB of 12

2) CPK-MM greater than the CPK-MB

3) Troponin 1 of 0.3

4) CPK total of 80

[luvyrpets]

Another one

A patient is admitted to the Telemetry unit with chest pain. A hour after admission the patient develops a narrow complex, tachycardia th rate of 160 and is regular. The patients vital signs are BP 100/65, P160, RR 20 and o2 at 95% on room air. which would be most appropriate for this patient?

1} 12 lead EKG which is what I said and got wrong

2} consider adenosine IV

3} consider defibrillation

4} wait to determine how long the patient will tolerate rhythm

I am torn between 2 and 4

Thanks

[KBICU]

Is this for homework? Best to research the enzymes listed individually to determine which one is CARDIAC specific -- being troponin. Others can indicate muscle damage but isn't cardiac specific. For the second question I would look up indications for adenosine and determine if it fits that rhythm. Waiting on a patient in an unstable rhythm will never be the answer - the patient will only tolerate the rhythm so long.

[squatmunkie_RN]

I work on a tele floor where these scenarios are common.

The 1st answer is troponin. The 2nd answer in the real world would be get the 12 lead EKG and call the doc. Which then he'd probably give you an order for some metoprolol IV or digoxin IV.... I wouldn't wait to see how long a pt would tolerate a sustained HR of 160s....

Adenosine is used to treat SVT, but in the real world nursing a pt won't get it for a HR in the 160s, as there are better drugs to treat.

Nursing school is designed to fail you. #2 is a very stupid question. But the answer is "consider adenosine IV"

[psu_213, BSN, RN]

Nursing school is designed to fail you. #2 is a very stupid question. But the answer is "consider adenosine IV"

Yeah, I don't know of a doctor that would treat a narrow, perfusing rhythm without getting an EKG first. I know this is supposed to be a straightforward (test?) question, but it should specify if the rhythm is regular or not.

As an ER nurse, I've found that medics love to give adenosine, but most times the rhythm for a HR of 160 turns A fib with RVR.

If it was regular and other VSS, go with vagal maneuvers before drugs or electricity.